The Fragmentation of U.S. Health Care

Causes and Solutions

Einer Elhauge

Selling point: Provides explanation of overarching aspects of the U.S. health care system

Selling point: Features evaluation of medical and hospital organization by authors with divergent perspectives and approaches

Selling point: Provides suggestions of health care reforms based on the application of theory and tools from law, industry best practice, and economic policy

The Fragmentation of U.S. Health Care

Causes and Solutions

Einer Elhauge

Description

Why is our health care system so fragmented in the care it gives patients? Why is there little coordination amongst the many doctors who treat individual patients, who often even lack access to a common set of medical records? Why is fragmentation a problem even within a single hospital, where errors or miscommunications often seem to result from poor coordination amongst the myriad of professionals treating any one individual patient? Why is health care fragmented both over time, so that too little is spent on preventive care, and across patients, so that resources are often misallocated to the patients who need it least? The Fragmentation of U.S. HealthCare: Causes and Solutions approaches these broad questions with a highly interdisciplinary approach.

The articles included in the work address legal and regulatory issues, including laws that mandate separate payments for each provider, restrict hospitals or others from controlling or rewarding the set of providers treating a patient to assure coordinated care, and provide affirmative disincentives for coordinating care by paying more for uncoordinated care that requires more services. Business reasons for the current form of hospital organization are considered, and efficiency and design are examined and compared to other industries. The economics of current hospital organization are also taken into account. The authors examine and propose various reforms that make our health care system less fragmented, more efficient, and more medically effective.

The Fragmentation of U.S. Health Care

Causes and Solutions

Einer Elhauge

Table of Contents

Our Fragmented Health Care System: Causes and Solutions Why We Should Care About Healthcare Fragmentation and How to Fix It - Einer Elhauge Health Care Fragmentation: We Get What We Pay For — David Hyman Organizational Fragmentation and Care Quality in the US Health Care System — Randal Cebul, James Rebitzer, Lowell J. Taylor, & Mark Votruba Curing Fragmentation With Integrated Delivery Systems: What They Do, What Has Blocked Them, Why We Need Them, And How To Get There From Here — Alain Enthoven Defragmenting Health Care Delivery Through Quality Reporting — Kristin Madison Competition Policy and Organizational Fragmentation in Health Care — Thomas Greaney Of Doctors and Hospitals: Setting the Analytical Framework for Managing and Regulating the Relationship — James Blumstein Property, Privacy and the Pursuit of Integrated Medical Records — Mark A. Hall Value-Based Purchasing Opportunities in Traditional Medicare: A Proposal and Legal Evaluation — Lawrence Casalino & Timothy Jost A More Equitable and Efficient Approach to Insuring the Uninsurable — Eric Helland & Jonathan Klick Ending the Specialty Hospital Wars: A Plea for Pilot Programs as Information-Forcing Regulatory Design — Frank Pasquale Fragmentation in Mental Health Benefits and Services: A Preliminary Examination into Consumption and Outcomes — Barak Richman, Dan Grossman, & Frank Sloan From Visible Harm to Relative Risk: Overcoming Fragmented Pharmacovigilance? — Arthur Daemmrich The US Healthcare System: A Product of American History and Values — David Johnson & Nancy Kane American Health Care Policy and Politics: Is Fragmentation a Helpful Category for Understanding Health Reform Experience and Prospects? — Theodore Marmor

The Fragmentation of U.S. Health Care

Causes and Solutions

Einer Elhauge

Author Information

Einer Elhauge

Einer Elhauge is the Petrie Professor of Law at Harvard Law School and founding director of the Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics. He served as Chairman of the Antitrust Advisory Committee to the Obama Campaign and member of Various Health Policy Advisory Committees to that campaign. He teaches a gamut of courses ranging from Antitrust, Contracts, Corporations, Legislation, and Health Care Law. Before coming to Harvard, he was a Professor of Law at the University of California at Berkeley, and clerked for Judge Norris on the 9th Circuit and Justice Brennan on the Supreme Court. He received both his A.B. and his J.D. from Harvard, graduating first in his law school class.